Post-Traumatic Stress Disorder in Children Per the DSM-5
The DSM-5 has specific criteria for Post-Traumatic Stress Disorder for children six years and younger. These criteria include exposure to a traumatic event such as sexual violence. Because of the event, one or more of the following intrusion symptoms may occur:
Recurrent, involuntary, and intrusive memories of the traumatic event. Intrusive memories, feelings or somatic symptoms, avoidance, negative alteration in mood and cognition, and alterations in arousal and sensitivity.
Recurrent distressing dreams in which the content or the affect of the dreams are related to the traumatic event
Dissociative reactions, the most extreme being a complete loss of awareness of present surroundings
Intense psychological distress and marked physiological responses to reminders of the traumatic event
Also, children can avoid activities, places, or reminders of the event and avoid interpersonal situations that are reminders of the event. As well, children may present with alterations in cognition such as increased frequency of negative emotional states (e.g., fear, guilt, sadness, shame, confusion), constriction of play, socially withdrawn behavior, and persistent reduction of positive emotions.
Children also exhibit alteration in arousal and reactivity associated with the traumatic event. The criteria require two or more of the following:
Irritable behavior and angry outbursts, often with little provocation, typically expressed as verbal or physical aggression toward people or objects, including extreme temper tantrums.
Hypervigilance
Problem with concentration
Sleep disturbance, including difficulties falling asleep or staying asleep or restless sleep.
Additional criteria include that the disturbance’s duration must last for more than one month, must cause clinically significant distress or impairment in relationships, and must not be attributable to the physiological effects of a substance like medication or alcohol.
Traumatic experiences can cause alterations in brain function. They can also cause long-term brain chemistry and brain circuitry changes, even when the traumatic event’s memories have faded from consciousness. The trauma sensitizes the brain, so traumatic experiences later become painful reminders of the original experience and cause individuals to overreact.
These alterations can have long-term consequences. For instance, depressive disorders are more frequent in individuals who have been sexually molested. Also, suicidal ideations and suicide are more common in the victims of sexual abuse. The rates in individuals who have been sexually molested as children are even higher. Sexual dysfunction is a risk factor following incidents of sexual molestation.
In children and adolescents, life transitions can destabilize an individual’s psychological homeostasis. Changes from preadolescence to adolescence, young adulthood, and then to the working world bring their own stresses, rekindling early traumatic experiences. The transitions are even more difficult in individuals who already present with emotional difficulties and instability.